Seated at the Tables of Influence

By Maureen Thielemans

A new Institute of Medicine Fellowship provides pharmacy with the opportunity to make a significant impact at the national level.

Dr. Samuel G. Johnson wears multiple hats: clinical pharmacy specialist at Kaiser Permanente Colorado, clinical assistant professor at the University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, avid social media user and pharmacogenomics expert. Last year he added another important designation to his credentials: Institute of Medicine (IOM) Anniversary Fellow in Pharmacy.

With a background in cardiovascular pharmacotherapy, and specifically pharmacogenomics, Johnson’s research has focused on the best way to implement personalized medicine programs within the nation’s health systems. This means utilizing information about a patient, including factors such as family history, diseases and genetic data, to personalize care. “It’s not just about the basic science piece or the translational piece,” he said. “It’s about how we do this in the real world, with real patients, efficiently and cost effectively.”

Academic Pharmacy Now takes a look at how Johnson is using this opportunity to move the needle when it comes to implementing pharmacogenomics programs in U.S. health systems and why it’s important to bring attention to the work of our members at the national level.

A Coveted Seat

The IOM pharmacy fellowship is part of a broader fellowship program created to honor the IOM’s 35th anniversary by enabling talented, early-career health science scholars to participate actively in IOM initiatives and further their careers as future leaders in the field.

In 2012, AACP president-elect J. Lyle Bootman, Ph.D., addressed the Academy at the Annual Meeting and led the charge to strengthen the IOM’s focus on critical pharmacy issues. “There has never been a more important time for academic pharmacy, and AACP specifically, to ‘get to all the right tables of influence at the right time.’ The good news is that we don’t come empty-handed. Our Association dedicates substantial time and effort to environmental scanning and the critical analysis of opportunities to advance pharmacy education, research and practice.”

AACP and the American College of Clinical Pharmacy endowed the fellowship with contributions of $150,000 each, and donations from Research Corporation Technologies and Academy members added additional support. “There are very few pharmacists elected to the Institute, which creates a tremendous opportunity for influence,” Johnson noted. “I hope to translate this experience to my colleagues and the trainees that I work with to illustrate the opportunity and hopefully inspire people to take advantage of it.”

Jumping In With Both Feet

From the beginning of his tenure as the inaugural fellow, Johnson knew he wanted to be very active in the work of the IOM, and its roundtables provided him the first opportunity to do so. “I didn’t want to just shadow and attend meetings,” he said. The roundtable groups, which primarily facilitate discussion and commentary, schedule workshops around particular themes that are developed within smaller sub-groups of the roundtable membership.

Johnson’s first project is as a member of the Roundtable on Translating Genomic-Based Research for Health. One of the roundtable’s goals is to identify the best practices across the country for implementing pharmacogenomics or genomic medicine programs within health systems. “Through a landscape survey, I’m trying to recognize institutions that are innovative leaders in the field of genomic medicine,” he said. “Key questions we asked included: What elements are critical to a successful program implementation? What metrics did they use to define success? What was their timeframe?”

Pharmacy Plays a Role

Through hour-long phone interviews with health system leaders and a few in-person site visits, Johnson identified some exemplary models of successful pharmacogenomics programs. The first is St. Jude’s Research Hospital in Memphis, which executed a vision that is pharmacist-led. Their program places a large emphasis on practice-based research and they’ve implemented a protocol to do pre-emptive genotyping with their predominantly pediatric patients. The genetic testing information for specific drug-gene pairs is combined with clinical decision support tools within the electronic medical record to optimize the use of this information. Additionally, St. Jude’s has an oversight committee that evaluates all the drug-gene pairs to determine which are clinically relevant, which means that having a specific genotype can change or alter care. They also collect information on other gene variants that they store in a research database.

Vanderbilt University Hospital has a similar approach but a different leadership strategy. Its PREDICT program is led by a group of physicians, and while pharmacists are involved, program leaders admit it was late in the game. They use a pharmacogenetics panel that provides information on up to 200 genes, and based on oversight and guidelines, they implement the drug pairs that are clinically actionable. Others are stored in a research database. Program leaders estimated that that they could save up to $5 million over a five-year period by implementing this pre-emptive genotype program and avoiding unnecessary adverse drug reactions.

“This is not science fiction,” Johnson said. “This is happening now. The profession of pharmacy has a huge opportunity to latch on to pharmacogenomics and personalized healthcare, and that can be targeted at multiple levels—education, practice and advocacy.”

Applying Lessons Learned

Throughout the fellowship, Johnson is bringing the knowledge and skills he’s learned back to his home institution. The University of Colorado school of pharmacy is revising and implementing a new curriculum, of which a pharmacogenomics course is required. “As part of this fellowship I’ve had the opportunity to contribute to the didactic portion and participate in the experiential education training of IPPE and APPE students specific to clinical pharmacogenomics. When you’re trying to implement something clinically, it’s invaluable to provide that experience to students and postgraduate trainees. This is where the rubber meets the road in clinical practice and patient care.”

During the second year of Johnson’s fellowship, he’ll also participate in a consensus study within the IOM Roundtable on Value and Science-Driven Healthcare, which is evaluating core metrics for quality healthcare across the United States. The study will provide evidence-based recommendations for which metrics should be used by our healthcare system to promote better health and assist the shift away from fee-for-service models and toward pay-for-quality models.

Culture Shock

Johnson’s tenure as the IOM Anniversary Fellow in Pharmacy will conclude next year, but he knows his work isn’t over. He’ll continue to learn from experts in the field, network with thought leaders and promote the importance of taking advantage of these opportunities to colleagues and students.

“Culture trumps strategy every time,” he said. “The culture of our healthcare system, with respect to seats of power, heavily favors nursing and medical physicians, and so it is critical to develop positions and advance pharmacy to be at an equivalent role in the national healthcare culture. This is just one of the ways to do that.”